Fingertip Replantation

Hattori, Yasunori; Doi, Kazuteru; Sakamoto, Soutetsu; Yamasaki, Hiroshi; Wahegaonkar, Abhijeet L.; Addosooki, Ahmad

doi:10.1016/j.jhsa.2007.01.019

Cited by 67 publications

(59 citation statements)

References 22 publications

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“…Multiple studies have observed that replantation is popular in Asian countries because there is Confucian moral values in the Far East, and appearance and bodily integrity are especially stressed. (22,23) Our results partially support this because there was significant difference in body integrity between the US and Japan, but only for nonmedical professionals. Conversely, there was no significant difference in estimate on stigma towards finger amputees, while Kojima pointed out that Japanese people exhibited strong stigma towards disability because of relative homogeneity and a general intolerance of difference.…”

Section: Discussionsupporting

confidence: 56%

A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan

Nishizuka

Shauver

Zhong

et al. 2015

The Journal of Hand Surgery

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Purpose To compare the societal preferences for finger replantation between US and Japan and to investigate factors influencing the preferences. Methods A sample of the general population without current hand disease or condition was recruited via flyers posted in public areas of 2 major academic centers in the US and Japan. The recruited subjects completed a survey presenting finger amputation scenarios and various factors that may affect treatment decisions. We performed univariate analysis using treatment preference as the outcome and all other factors as possible predictors using the chi-square test. Results The majority of respondents in both countries preferred replantation, and there was no significant difference between the US and Japan. Treatment preference was significantly associated with the importance of appearance, recovery time, and the chance of survival of the replanted digit. There was no association between treatment preference and attitudes on body integrity or estimate of stigma towards finger amputees. Japanese participants agreed more with statements of body integrity, and Japanese respondents rated appearance, sensation, and chance of survival of the replant as more important than American participants. Conclusions Patient preference is not driving the decrease in finger replantations in the US. The general public in both countries prefer replantation over wound closure for digit amputations. Level of Evidence Economic/Decision Analysis Level III

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Section: Discussionsupporting

confidence: 56%

A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan

Nishizuka

Shauver

Zhong

et al. 2015

The Journal of Hand Surgery

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“…Pulp atrophy is believed to be related to type of injury and post-operative vascular complications. 54 In our review, the study by Hahn et al 31 contributed the largest number of patients (n=469) to the late follow-up groups for both nail deformity (72%) and pulp atrophy (73%). Their study included only zone I amputations and they recommended repairing as many veins as possible to reduce these complications.…”

Section: Discussionmentioning

confidence: 97%

“…Surgeons from the Orient cite Confucian moral values and a greater emphasis on maintaining body integrity and physical appearance as a reason for doing these procedures. 22, 23, 25, 31, 54 Unlike proximal digital replantations, the outcome of a distal digital replantation depends mainly on survival. Bony fixation is simple and needs one or two longitudinal Kirschner wires.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of the Outcomes of Replantation of Distal Digital Amputation

Sebastin¹,

Chung²

2011

Plastic and Reconstructive Surgery

235

230

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Background The aim of this study is to conduct a systematic review of the English literature on replantation of distal digital amputations to provide the best evidence of survival rates and functional outcomes. Methods A MEDLINE search using “digit, finger, thumb, and replantation” as keywords and limited to humans and the English language identified 1297 studies. Studies were included in the review if they: (1) present primary data; (2) report 5 or more single or multiple distal replantations; (3) present survival rates. Additional data extracted from the studies meeting the inclusion criteria included demographic information, nature and level of amputation, venous outflow technique, nerve repair, recovery of sensibility, range of motion, return to work, and complications. Results 30 studies representing 2,273 distal replantations met the inclusion criteria. The mean survival rate was 86%. There was no difference in survival between zone I and zone II replantations (Tamai classification). There was a significant difference in survival between replantation of clean-cut versus the more crushed amputations (crush-cut and crush-avulsion). The repair of a vein improved survival in both zone I and zone II replantation. The mean 2-PD was 7mm (n=220) and 98% returned to work (n=98). Complications included pulp atrophy in 14% of patients (n=639) and nail deformity in 23% (n=653). Conclusion The common perception that distal replantation is associated with little functional gain is not based on scientific evidence. This systematic review showed a high success rate and good functional outcomes following distal digital replantation.

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“…A meta-analysis that looked at a total of 1103 replants from eight different studies showed an overall 92 % survival rate, none of which were UK or European-based studies [3]. A number of papers have solely assessed distal fingertip replantations again none from within Europe [4][5][6][7]. In the USA where state-funded health care is limited, patients were less likely to have a replant attempted when funded by Medicare (5 %), Self-pay (13 %) or Medicaid (14 %) [8].…”

Section: Introductionmentioning

confidence: 99%

Results of upper limb digital and hand replant and revascularisation at a UK Hand Centre

2015

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Background There is an increasing awareness of replantation amongst the general public, with an expectation for reattachment of digits. Currently, there is a paucity of evidence on the outcomes of replantation or revascularisations in the UK with most surgical experience literature from the USA or East Asian countries. Methods We report a case series of 28 patients over a 7-year period with replantation or revascularisation performed at a tertiary National Health Service hand centre in the UK. Data was collected retrospectively from hospital clinical notes and electronic imaging. Results Out of the 28 patients identified, 16 had single digit replantation or revascularisation, of which 11 digits ultimately survived. Nine patients underwent multiple digit replantation or revascularisation with a combined total of 25 digits, only five of these digits survived.Conclusions Factors found to adversely affect survival were increased number of attempted replants, power-saw mechanism of injury and prolonged ischaemic time. Reduced ischaemic times and single digit amputations were associated with improved survival. Level of Evidence: level IV, risk/prognostic study.

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Fingertip Replantation

Cited by 67 publications

References 22 publications

A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan

A Comparative Study of Attitudes Regarding Digit Replantation in the United States and Japan

A Systematic Review of the Outcomes of Replantation of Distal Digital Amputation

Results of upper limb digital and hand replant and revascularisation at a UK Hand Centre

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